What Is a Hematoma?

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A hematoma is an abnormal pooling of blood that results from a broken or ruptured blood vessel. Hematomas are more serious than "simple bruises." They can occur anywhere in the body and vary in severity depending on the nature of the injury. The most common symptoms are pain and swelling. A minor impact can cause skin discoloration, while a harder impact can cause a collection of clotted blood deep within a muscle, organ, or the skull that can require immediate medical attention and be life-threatening. Treatment can vary from basic first aid to emergency surgery. Head impacts are of particular concern because of the risk for traumatic brain injury.

Types of Hematoma

Hematomas in specific areas of the body have their own complicating factors. They include:

  • Auricular: A hematoma in the ear can affect blood supply and cause tissues of the ear to die. It can also cause deformity, aka "cauliflower ear."
  • Septal: Blood collects in the septum, the area of the nose between the nostrils. The mucoperichondrium, which covers the septal cartilage, separates from the cartilage, causing blood to pool. This type of hematoma is most often related to a broken nose, or as a complication from septum surgery. 
  • Intramuscular: This is a hematoma within muscle tissue and can be painful due to inflammation, swelling, and irritation. When the blood supply in the muscle is affected, nerves may be harmed. This type is often seen in the lower legs and lower arms.
  • Abdominal: These hematomas can occur within the abdomen (intrabdominal) or within the abdominal wall (usually from abdominal muscle bleeding). These hematomas also can cause blood buildup in organs such as the kidneys and liver.
  • Subungual: Hematomas pooling under a toenail or fingernail can cause pressure and pain.
  • Subcutaneous: These occur under the skin and affect the shallow veins. People on blood-thinning medications are the most susceptible to subcutaneous hematomas. 

Intracranial

A hematoma in the head is likely to be considerably more serious than one in any other part of the body as it is associated with traumatic brain injury.

Intracranial hematomas can grow slowly or rapidly, but regardless of the speed of growth, they can put pressure on the brain that, if not treated promptly, can result in coma or death.

The types of intracranial hematomas are:

  • Intracerebral: Blood pools within the brain due to injury.
  • Epidural: This type is also called an extradural hematoma, in which bleeding occurs between the skull and the brain's protective covering (the dura). It is seen in skull fractures in children and adolescents because their dura is not as firmly attached to the skull.
  • Subdural: The bleeding occurs from the veins on the surface of the brain and collects between the surface of the brain and the dura covering the brain.

Symptoms

Hematomas near the skin result in a large patch of skin discoloration (typically dark red or black and blue) that results from trauma to the soft tissue.

Hematomas cause pain, swelling, and tenderness over the area of skin discoloration or deep within the body.

Signs of intracranial hematomas include headache, vomiting, drowsiness, dizziness, confusion, slurring of speech, and unequal pupil size. Symptoms of intracerebral hematoma may also include paralysis on the side of the body opposite the hematoma.

Most intracranial hematomas develop rapidly after an injury and cause symptoms within minutes. However, they can also appear hours to days or even weeks later.

Important note: Subdural hematomas can be acute or chronic. Acute subdural hematomas occur from a traumatic injury and generally present quickly. Chronic subdural hematomas, which are small and happen repeatedly over time, are more common in older adults, people who take anticoagulants, and those who abuse alcohol.

By the time symptoms are noticeable, a chronic subdural hematoma may be very large. Chronic hematomas are less likely than acute hematomas to cause a rapid increase of pressure within the skull.

Causes

Hematomas are caused by a bodily injury, usually a hard impact, that damages blood vessels enough to cause blood to pool in the area.

Intracranial hematomas can occur in a serious head injury, but may also occur in minor head injuries in people who may have clotting problems or weakened blood vessels from age and/or excessive alcohol use.

Head injuries in sports should always be treated immediately because of potential traumatic brain injury. Any loss of consciousness, however brief, needs follow-up with a health care provider.

Diagnosis

Less-serious hematomas can be diagnosed by physical examination, though they don't generally require a doctor's care.

Hematomas near major organs, particularly intracranial hematomas, require imaging technology to be diagnosed. Head hematomas usually are diagnosed from a computed tomography (CT) scan or magnetic resonance imaging (MRI).

Treatment

Treating a superficial hematoma is similar to treating other soft tissue injuries. Using the R.I.C.E method (rest, ice, compression, elevation) is recommended. Apply ice to the area for 15 minutes, several times per day. Mild hematomas and contusions typically heal within about five days.

A large hematoma may last weeks to months and as it heals it will change color and slowly shrink in size.

Hematoma pain and swelling may be treated with over-the-counter (OTC) pain medications. Aspirin should not be used as it may increase bleeding.

Treatment for more serious hematomas will depend on the size of the hematoma, whether the bleeding is still an issue, and other problems the hematoma may cause. Treatment can vary from first aid to major surgery.

If large enough, intracranial hematomas can be treated by drilling holes in the skull to allow blood to drain. More serious surgery may be required if the bleeding needs to be addressed.

A Word From Verywell

Hematomas can range from harmless to life-threatening. People who are most at-risk for hematomas should be vigilant. This includes older adults, anyone who has suffered a physical trauma, and people prescribed blood thinners. Head injuries are particularly worrisome. Proper use of helmets in sports and recreational activities such as skiing and cycling aims to prevent this sort of injury.

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Article Sources
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  7. U.S. National Library of Medicine. MedlinePlus. Subdural hematoma. Updated April 30, 2018.

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